MEDICARE: HAMMOND DIALYSIS CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1104273457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMMOND DIALYSIS CLINIC LLC

Provider Business Mailing Address
First Line	:	42286 VETERANS AVE
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1423
Country	:	US
Telephone Number	:	985-345-8855
Fax Number	:	985-345-8856

Provider Business Practice Location Address
First Line	:	42286 VETERANS AVE
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1423
Country	:	US
Telephone Number	:	985-345-8855
Fax Number	:	985-345-8856

Authorized Official
Title or Position	:	CHIEF NURSING OFFICER
Name	:	SARA ANNE BRADY
Credential	:
Telephone Number	:	208-371-7878

Provider Enumeration Date	:	05/17/2016
Last Update Date	:	01/10/2023

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